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Schlafverhalten und Kopfschmerzattacken bei primären Kopfschmerzen

Mögliche Pathomechanismen

Sleeping behaviour and headache attacks in cases of primary headache

Possible pathological mechanisms

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Zusammenfassung

Die bevorzugte Auslösung von Kopfschmerzattacken im REM-Schlaf für den Hypnic-Headache und die chronisch paroxysmale Hemikranie gilt als gesichert und für den Clusterkopfschmerz und die Migräne als möglich. Typisch für den REM-Schlaf sind pontogenikulookzipitale Spikes (PGO).Wesentlich für primäre Kopfschmerzen (v. a. Migräne, Clusterkopfschmerz und andere trigeminoautonome Kopfschmerzen (TAC)) könnte eine klinisch stumme kortikale Spreading-Depression sein, die möglicherweise durch PGO getriggert wird. Dadurch könnte es sekundär zur Aktivierung trigeminovaskulärer Afferenzen mit dem Symptom „Kopfschmerz“ kommen. Diese These wird durch die Beobachtung gestützt, dass bei Erkrankungen, die eine Komorbidität mit Migräne aufweisen, auch der REM-Schlaf vermehrt ist und dass verschiedene Medikamente zur Prophylaxe zu einer Reduktion des REM-Schlafes führen.

Abstract

Headache is connected with sleep quality, e.g. hypnic headache and chronic paroxysmal headache attacks occur preferentially during REM sleep; this is possibly also true for cluster headache and migraine. REM sleep is typically characterized by the occurrence of ponto-geniculo-occipital spikes (PGOs). These PGOs should be able to trigger cortical spreading depression (CSD), which, although often clinically silent, is assumed to be an essential element of a migraine attack and possibly also of other forms of headache. CSDs are considered a correlate of migraine aura. They could lead to the secondary activation of trigeminovascular afferences, which would then induce a headache. Interestingly, illnesses that are comorbid with migraine cause an increase in the amount of REM sleep; conversely, various drugs administered prophylactically for these illnesses reduce the quantity of REM sleep.

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  1. Neurologische Klinik der Universität München, Standort Großhadern

    A. Straube & S. Förderreuther

  2. Neurologische Klinik im Klinikum Großhadern, Marchioninistraße 15, 81377 , München

    A. Straube

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Straube, A., Förderreuther, S. Schlafverhalten und Kopfschmerzattacken bei primären Kopfschmerzen. Schmerz 18, 300–305 (2004). https://doi.org/10.1007/s00482-004-0311-9

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